Treatment of shingles
The treatment goal of shingles is to relieve acute pain, shorten the duration of skin lesions, prevent skin lesions from spreading, and prevent or reduce complications such as neuralgia after zoster.
1. Anti -virus drug:
It is a commonly used drug with shingles clinically. It can effectively shorten the course of the disease, accelerate rash healing, reduce the formation of new rash, and reduce virus spread to internal organs. It should be used within 24 to 72 h after the hair rash to quickly achieve and maintain the effective concentration to obtain the best treatment effect. The systemic antiviral drugs currently approved include Agelovirville, Paolovirovir, Pancostelvir, Carcarb, and sodium methamphaate.
Infected in the infection of virus thyleneosine phosphate phosphoric acid, generates triop phosphoric acid in germo, the latter can inhibit the virus DNA polymerase and stop the extension of the virus DNA chain.
Oral: 400 ~ 800 mg/time, 5 times/d, 7 d; intravenous dripping: 5 to 10 mg/kg each time in patients with immune damage or severe nervous system disease Essence
Agelovovir’s pre -body drug is quickly absorbed by oral absorption, and it is rapidly converted into Agelovirville in the gastrointestinal tract and liver. Its biological utilization is 3 to 5 times that of Agelovir.
Oral: 300 to 1 000 mg/time, 3 times/d, take 7 d.
Sitenurovir’s pre -body drug was quickly transformed into spit cosmovir after orally, which maintained a long half -life in the cells. The action mechanism is higher than the Agelovir, and the biological utilization is higher than that of Agelovir, and the frequency and dose of administration are lower than Agelovir.
Oral: 50-500 mg/time, 3 times/d, take 7 d.
The antiviral effect is highly selective, and the process of inhibiting virus replication is only performed in the cells of the virus infection.
Oral: 125 mg/d, 1 time/d, take 7 d.
The phosphate binding part of the virus DNA polymerase is blocked by non -competitive way to prevent the extension of the DNA virus chain.
Intravenous drip: 40 mg/kg each time, once every 8 hours.
Note: During the administration of Agelovir, patients should drink enough water to prevent Agelovova from precipitating in the renal tube and damage renal function.
Patients with incomplete renal function should be reduced accordingly. Those who continue to decline in renal function should be discontinued immediately and switched to Panchenlovi or other antiviral drugs to continue treatment. Patients suspected of having renal insufficiency should initially detect creatinine levels before administration, but bromine does not need to detect creatinine levels.
Guidelines for the American Infection Society recommendation of Agelovova to treat chickenpox-meningitis/encephalitis caused by shingles virus: mild medium case, intravenous drop 10 mg/kg, once every 8 hours, continuous treatment 10 ～ 14 D, and severe cases should be continuously treated for 14-21 d.
HIV with chickenpox-shingles-shaped virus infection, it is recommended to use Agelovovirville or sodium sodium methampate. Pic-scholarly visual neuritis caused by herpes zoster virus is rare. It almost only appears in HIV serum response-positive AIDS patients. At the same time, it can be accompanied by or without skin lesions. There is currently no clear and effective treatment plan. However, since the optic neuritis can seriously endanger vision and tissue pathology shows inflammation and inflammation, the initial giving intravenous injection of Agelvevilvir and glucocorticoids can be considered. Recommended sodium tadplate.
2. Glucocorticoid therapy:
At present, there is still controversy about whether glucocorticoids are treated with shingles. It is generally believed that the early system should be used to apply glucocorticoids in the early system of shingles and gradually decreases. It can inhibit the inflammation process and shorten the duration and healing time of acute pain, but the pain of neuralgia after zostering has occurred. The recommended dose of Domatsuyon’s initial amount is 30 to 40 mg/d orally, and the amount is gradually reduced, and the course of treatment is 1 to 2 weeks. Whether the therapy can prevent neuralgia after zostering is still controversial.
Age -shaped shingles, herpes herpesitis, and visceral shingles that occur with a large area of rash and severe pain, accumulating the head and facial sides of the head and face, and the viscerals. Patients with hypertension, diabetes, digestive ulcers and osteoporosis are used with caution, and patients who are immunosuppressive or taboo. It is recommended to use Ramsay Hunt syndrome and central nervous system complications such as Ramsay Hunt syndrome and central nervous system, such as encephalitis or Bell.
3. An analgesic treatment with a shingles period:
For mild and moderate pain, consider prescriptions for acetylinophenol, non -steroidal anti -inflammatory drugs or curge.
Medium to severe pain uses opioids, such as morphine or hydroxyltho, or drugs that treat neuropathological pain, such as calcium ion channel regulators plus spray, Pilebalin and so on.
Severe acute pain during shingles is a risk factor for neuralgia after shingles. The combined calcium ion channel regulator can not only effectively relieve pain, but also reduce neuralgia after zoster. Studies have shown that the early use of Prybalein can significantly reduce the pain score of the zosterized stage, especially in the epitax of herpes that can significantly reduce the incidence of nerve pain after zoster.
The pain of patients with herpes zoster is more common and severe, which seriously affects all aspects of life, such as anxiety, sleep disorders, unable to work or live normally. Studies have shown that the combined hydroxylkone in Prybalen can not only further reduce the incidence of nerve pain after zostering, but also improve patients’ daily activities and sleep, and improve the quality of life.
The second -generation calcium ion channel regulator is strong with α2⁃Δ subunit. By adjusting the influx of calcium ions, the excessive release of excitement neurotransmitters can be reduced, and the analgesic effect is achieved. Fast effect, linear pharmacokinetic characteristics, have no cap effect on the effect.
Oral: The starting dose is 150 mg/d, which can be increased to 300 mg/d within 1 week. Patients with renal stabilization should adjust the dose. The maximum dose is 600 mg/d.
Patients with incomplete renal function should be reduced. The main adverse reactions are dizziness and drowsiness.
The first generation of calcium ion channel regulators shows the characteristics of non -linear pharmacokinetic dynamics, and the curative effect has a cap effect.
Oral: The starting dose is 300 mg/d, which gradually increases to the most suitable dose. The commonly used dose is 900 to 1 800 mg/d.
Adverse reactions are the same as Proven.
Multiple links that can be used in pain conduction pathways: blocking multiple ionic channels, inhibiting the re -intake of 5 hydroxylidine and norepinephrine, which mainly play a role in pain transmission downward pathways.
Oral: The starting dose is 25 mg/d, and the maximum dose is 150 mg/d.
Pay attention to its heart toxicity, glaucoma, urine retention, suicide and other high -risk patients with caution.
Block the voltage door control sodium ion channel, reduce the ectopic impulse of the initial transmission after the injury, thereby reducing the pain.
Pain area 1 to 3 stickers, 1 sticker up to 12 h.
Skin reactions are used, such as itching, erythema and dermatitis.
4. The clinical characteristics and treatment of shingles with special crowds:
Children who suffer from chickenpox during infants and mothers are more likely to have shingles, but the onset is lighter than adults. It can take 20 mg/kg of Agellovi, 4 times/d.
Or weigh the advantages and disadvantages. After fully communicating with the parents of the children, they take the Pancculova carefully. <40 kg people with a weight of 12.5 mg/kg each time once 8 hours, and the weight of ≥ 40 kg is 250-500 mg once every 8 hours.
Critical patients can drop Agelovovir, ≤ 500 mg/m2 or ≤ 15 mg/kg, once every 8 hours.
Elderly people are prone to skin, viscera, and complications. It is advisable to use high -efficiency and low toxic antiviral drugs to actively treat. Contraindications can also be treated with glucocorticoids.
Patients in advanced pregnancy can take Osqilovovovirville or Paolifirville. In severe cases, I can use the veins of Agelovir, but they should be used with caution before 20 weeks of pregnancy.
During the lactation, Agelovova did not see the abnormalities of breasts, but orally Panchenlow had to stop breastfeeding.
5. Education of patients with shingles:
Health education is of great significance for patients’ understanding of their own diseases, compliance, and reducing complications. Patients with fascinating liquid or erosion contain viruses, and children who have not yet suffered from chickenpox and other susceptibles should be avoided. Tell patients to seek medical treatment and treatment early, adhere to the correct drug dose and treatment, keep skin lesions clean, avoid secondary bacterial infections, rest proper rest, and ensure sufficient nutrition. Neur nutritional drugs also help to alleviate neuritis and neuralgia. Commonly used drugs include methamphetamine, vitamin B1 and vitamin B12, etc. Oral or intramuscular injection.
6. TCM treatment
Traditional Chinese medicine believes that the first disease is mostly damp -heat, dampness, and dampness. In the later period, most of them are caused by fire injuries, stagnation and blood stasis, or spleen deficiency, and the residual poison is not clear. In the early stage, it was based on clearing heat and dampness and detoxification.
Liver and gallballine damp -heat type
At the beginning of the onset, the rash was bright red, the clusters were gathered, the blisters were tense, the red burning tingling, the treatment should be clear and the heat and dampness, detoxifying and relieving pain. Use Longdan diarrhea soup. Chinese medicines can be selected from Longdan Xie Liver Pills, Jiawei Xiaoyao Pills, Shinya Shibin, and Qingkai Lingju.
Spleen deficiency and dampness:
The rash is red, the wall of the blisters is relaxed, and the erosion exudes more. Pain is painful. Use dehumidifying stomach soup. Chinese patent medicine can be selected.
Qi stagnation blood stasis
It is more common in the elderly. It can be seen that the rash is dark red or bloody, or the rash fades, but the pain is still more than the pain. Use the bloodfurns to compete and subtract. Chinese medicines can be selected from Qili San, Yunnan Baiyao, Bloodflowing Capsule Capsules, Rhubarb Pills, etc.
Acupuncture is a special therapy for Chinese medicine to treat shingles. It can be treated with fire needles, electro -needle, local pestamental, spines blood cup, acupoint injection or buried lines and moxibustion.
7. Local treatment
Physical therapy shingles currently lack high -quality research reports. Local heat therapy may have the effect of promoting skin loss. A retrospective comparison study in Taiwan has confirmed that the use of low -energy laser treatment within 5 days of shingles can significantly reduce the incidence of PHN, but further random comparison test verification is required.
External treatment drugs:
Mainly dry and anti -inflammatory. When the vessel liquid is not broken, it can be used for external glyphosate washing agent, Agelovoviri cream or spray cosimovir milk cream. 0.5 % newcomin ointment or 2 % Mupro star ointment. Eye can be used for external use of eye ointment, iodide (herpes net) eye drops, and disables topical preparations for glucocorticoids.
Eye Massage Instrument Recommendation: thermal therapy eye massasger